 Name the fives stages of HIV/AIDS infection.

 Identify four ways in which HIV can be contracted by occupational exposure.

 Name six Standard Precautions that must be followed in caring for an HIV-positive
patient.
 Identify the legal and ethical issues associated with HIV/AIDS.
 Identify five populations that are especially vulnerable to HIV/AIDS.
 Identify global and national resources for heath care professionals and clients with
HIV/AIDS.

HIV enters the bloodstream and seeks out T-helper lymphocytes, which are specialized white blood cells
essential to the functioning of the immune system.

This T-helper lymphocyte cell is also known as the T4 or the CD4 cell.

There are five stages of HIV/AIDS infection:

1. Primary or acute infection

2. The window period ending with seroconversion
3. The asymptomatic period
4. The symptomatic period
5. Full-blown AIDS

Primary or acute HIV infection is the first stage of HIV disease—typically lasting only a week or two—
when the virus first establishes itself in the body. This is the period of time between first infection and
when the body begins to produce antibodies.

Acute primary HIV infection is:

1. The period just preceding full-blown AIDS.

2. Referred to as the window period.
3. The first week or two after infection when the firus is still undetectable.
4. The time when antibodies are first detected

The window period is the period of time between initial infection with HIV and the point when the body
produces detectable antibodies, which can vary from 2 to 12 weeks. During the window period a person
is infectious, with a high viral load, but still presents with a negative HIV antibody test.

This means the infected person might get a negative test result while actually having HIV. The point
when the HIV antibody test becomes positive is called seroconversion. Patients also may remain
asymptomatic during the window period with no clinical manifestations, which decreases patient
motivation for testing.
The window period:

1. Is the time between infection with HIV and the body’s production of detectable
antibodies.
2. Typically lasts only a week or two.
3. Refers to the stage of disease when the newly infected person is not yet contagious.
4. Is the first stage of HIV disease.

his asymptomatic stage is sometimes referred to as clinical latency. This means that, although a
person looks and feels healthy, they can infect other people through any body fluid contact such as
unprotected anal, vaginal, or oral sex or through needle sharing

Unless the infected person is given antiretroviral therapy, the onset of AIDS occurs an average of 10
years after being infected with HIV.

Q: If a person has been infected with HIV but is not symptomatic, how would you explain this to
a patient with HIV?

A: Although there may be no clinical symptoms, the HIV is replicating and slowly attacking the
immune system’s CD4 cells. An untreated person can look and feel healthy, sometimes for many
years, however the virus is still present in the blood and can cause infection in others. Also, the
virus can be passed through unprotected sex and from pregnant or lactating mother to child.

During the asymptomatic state of HIV infection:

1. The virus can be passed through unprotected sex, but cannot be passed to a baby through
breastfeeding.
2. The virus is in the dormant stage and is not replicating.
3. People infected with HIV experience frequent illnesses.
4. An untreated person can look and feel healthy for an average of 10 years before the start
of AIDS symptoms.

The symptomatic stage occurs when clinical manifestations appear, including nausea, vomiting, cold and
flu-like symptoms, weight loss, malaise, and general infections. Because these symptoms occur with
many other illnesses, patients don’t recognize them as unique to HIV infection and often do not get
screened, tested, diagnosed, or treated. Clinical symptoms appear as the body’s immune system can no
longer respond effectively to other pathogens because the HIV has taken over the CD4 lymphocytes.

Autoimmune deficiency syndrome (AIDS) is always caused by HIV, but HIV is not always in the full state
of AIDS. Only after the HIV has completely infected the CD4 cells and used their metabolism and
multiplication ability is the body’s immune system incapacitated. AIDS is diagnosed when the CD4 count
is less than 200 compared with the normal range of 1,000 T cells in healthy people. Primary tests for
diagnosing HIV and AIDS include a positive ELISA test, viral load test, or Western Blot Test.
Autoimmune deficiency syndrome (AIDS) is always caused by HIV, but HIV is not always in the full state
of AIDS. Only after the HIV has completely infected the CD4 cells and used their metabolism and
multiplication ability is the body’s immune system incapacitated. AIDS is diagnosed when the CD4 count
is less than 200 compared with the normal range of 1,000 T cells in healthy people. Primary tests for
diagnosing HIV and AIDS include a positive ELISA test, viral load test, or Western Blot Test.

In 1999 an international team of researchers reported that they discovered the origins of HIV-1, the
predominant strain of HIV in the developed world. A subspecies of chimpanzees native to West
Equatorial Africa was identified as the original source of the virus. Researchers believe that HIV-1 was
introduced into the human population when hunters became exposed to infected blood.

the Centers for Disease Control and Prevention (CDC) estimate that 1.2 million people aged 13 years and
older are living with HIV infection, including 168,000 (14%) who are unaware of their infection. This is a
decline from 25% in 2003 and 20% in 2012, and it is a positive sign because studies have shown that
people with HIV who know that they are infected avoid behaviors that spread infection to others; also,
they can get medical care and take antiviral medications that could reduce HIV spread by as much as
96% (CDC, 2016a).

Necessary Conditions for HIV Infection

HIV is a relatively fragile virus that is not spread by casual contact. HIV is not easy to “catch”—
it must be acquired. In order for HIV to be transmitted, three conditions must occur:

 There must be an HIV source.

 There must be a sufficient dose of virus.
 There must be access to the bloodstream of another person.

transmission occurs primarily through infected blood, semen, vaginal secretions, or breast milk.

Sweat, tears, saliva, urine, and feces are not capable of transmitting HIV unless visibly contaminated
with blood.

The concentration and amount of HIV necessary for infection to occur is called a sufficient dose.

The most common of the risk behaviors are unprotected sexual intercourse (anal, vaginal, oral) with an
infected person, and use of contaminated injection equipment for drugs.
HIV is transmitted through:

 Unprotected anal, vaginal, and oral intercourse

 Sharing needles or other injection equipment
 A mother passing the virus to her baby either before or during birth
 An infected woman breastfeeding her infant
 Accidental needle stick injuries, or infected body fluid coming into contact with the
broken skin or mucous membranes of another person (as with healthcare workers)
 A transfusion prior to 1986 of HIV-infected blood or blood products

The transmission of HIV depends upon:

 The availability of the infectious agent (HIV) in sufficient quantity

 The viability of the infectious agent (how strong it is)
 The virulence of the infectious agent (how infectious it is)
 The ability of the infectious agent to reach the bloodstream, mucous membranes, or
broken skin of a potential host (the entry for getting into another person’s body)

The behavior associated with the highest risk of HIV transmission is:

1. Unprotected anal intercourse.

2. Unprotected vaginal intercourse.
3. Breastfeeding.
4. Direct sharing of drug paraphernalia.

The presence of infection with other STDs increases the risk of HIV transmission because:

 STDs like syphilis and symptomatic herpes can cause breaks in the skin, which provide
direct entry for HIV.
 Inflammation from STDs, such as chlamydia, makes it easier for HIV to enter and infect
the body.
 HIV is often detected in the pus or other discharge from genital ulcers of HIV-infected
men and women.
 Sores can bleed easily and come into contact with vaginal, cervical, oral, urethral, and
rectal tissues during sex.
 Inflammation appears to increase HIV viral shedding and the viral load in genital
secretions.

HIV is not transmitted through the air or by sneezing, breathing, or coughing. Touching, hugging, and
shaking hands do not transmit HIV

Biting poses very little risk of HIV transmission. The possibility only exists if the person who is
biting and the person who is bitten have an exchange of blood
The behavior associated with the highest risk of HIV transmission is:

1. Unprotected vaginal intercourse.

2. Breastfeeding.
3. Unprotected anal intercourse.

Q: A client wants to know what behaviors will increase his risk of HIV. What would you teach
him?

A: Your risk of exposure to HIV increases by risky behaviors such as having multiple sexual
partners, unprotected anal and vaginal intercourse and exposure to any used and infected IV ne If
there is no possible way to obtain new needles, the directions for using bleach to clean
syringes/needles follows:

1. Fill the syringe completely with water.

2. Tap it with your finger to loosen any traces of blood.
3. Shake the syringe and shoot out the bloody water.
4. Repeat these steps until you can’t see any blood. Then:
5. Fill the syringe completely with fresh bleach.
6. Keep the bleach inside the syringe for at least 30 seconds.
7. Shoot out the used bleach.
8. Rinse out the syringe with new, clean water.
9. Shake the syringe and squirt out the water

Occupational exposure means:

1. Exposure to food served by an HIV-infected employee.

2. Being infected by an occupational worker.
3. Caring for a patient who has HIV.
4. Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or
OPIM that may result from the performance of an employee’s duties.

Q: Healthcare professionals need to receive bloodborne pathogens training. What would

it include?
A: Training includes protective measures to minimize the risk and what to do if exposure
occurs.

bloodborne pathogens include any human pathogen present in human blood or OPIM
Bodily fluids that have been recognized as linked to the transmission of HIV, HBV and HCV,
and to which Standard Precautions apply, are:

 Blood
 Blood products
 Semen
 Vaginal secretions
 Cerebrospinal fluid
 Synovial (joint) fluid
 Pleural (lung) fluid
 Peritoneal (gut) fluid
 Pericardial (heart) fluid
 Amniotic (fluid surrounding the fetus) fluid
 Saliva in dental procedures
 Specimens with concentrated HIV, HBV and HCV viruses

Body fluids such as urine, feces, and vomitus are not considered OPIM unless visibly contaminated by
blood

Hand hygiene:

1. Is required after removal of gloves or other PPEs and upon leaving the work area.
2. Is not required after removing gloves.
3. Is required only after contact with blood or other infectious materials.
4. Includes the use of lotion to prevent dry skin.

A co-worker asks you how to dispose of regulated waste. How would you explain the process?

A: Regulated waste is suspicious of body fluids and may not be flushed down toilets and must be
placed in closeable, leakproof containers or bags and color-coded or labeled. It does also include
items on which blood has dried.

Needles are not to be recapped, purposely bent or broken, removed, or otherwise manipulated by
hand. After they are used, disposable syringes and needles, scalpel blades, and other sharp items are to
be immediately placed in puncture-resistant, labeled containers for disposal.

An occupational exposure to a bloodborne pathogen is defined as a percutaneous injury such as a

needle stick or cut with a sharp object, or contact of mucous membrane or non-intact skin (eg, exposed
skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or OPIM.